tbuckley/cabot-search huggingface dataset:
Preoperative α-blockade versus no blockade for pheochromocytoma–paraganglioma patients undergoing surgery: a systematic review and updated meta-analysis
Authors: Jue Wang, Qingyuan Liu, Shihao Jiang, Jindong Zhang, Jinke He, Yunfan Li, Delin Wang
Journal: International Journal of Surgery (2023)

Surgical resection of pheochromocytomas and paragangliomas (PPGLs) is associated with a significant risk of intraoperative hemodynamic instability and cardiovascular complications. α-blockade remains the routine preoperative medical preparation despite controversies over the lack of evidence. We presented an updated meta-analysis to ulteriorly evaluate the potential efficacy of preoperative α-blockade versus no blockade for PPGL patients undergoing surgery.Randomized and nonrandomized comparative studies assessing preoperative α-blockade for PPGL surgery in adults were identified through a systematic literature search via MEDLINE, Embase, Web of Science, and CENTRAL up to November 2022. Outcome data of intraoperative hemodynamic parameters and major postoperative events were extracted. Mean difference and risk ratio were synthesized as appropriate for each outcome to determine the cumulative effect size.Fifteen nonrandomized studies involving 3542 patients were finally eligible. Intraoperatively, none of the analyzed hemodynamic parameters differed between patients with or without α-blockade: maximum and minimum systolic blood pressure, hypertensive and hypotensive hemodynamic instability episodes, and peak heart rate, subgroup analysis of normotensive PPGL patients yielded similar results with the overall effects. Postoperatively, α-blockade was associated with prolonged hypotension and vasopressor usage (risk ratio: 4.21, 95% CI: 1.17-15.18, P =0.03). ICU admission, length of stay, overall cardiovascular morbidity, and mortality were similar between the two groups.Preoperative α-blockade ensured neither more stable intraoperative hemodynamics nor better perioperative outcome over no blockade for PPGL surgery. However, large-volume randomized controlled trials are still warranted to ascertain these findings.
Early assessment of circulating exosomal lncRNA-GC1 for monitoring neoadjuvant chemotherapy response in gastric cancer
Authors: Xin Guo, Yunge Gao, Qiying Song, Jiangpeng Wei, Jianfeng Wu, Jian Dong, Ligang Chen, Shenhui Xu, Di Wu, Xisheng Yang, Lubin Chen, Xiaohua Li, Gang Ji, Xiaohui Lv, Bo Wei
Journal: International Journal of Surgery (2023)

The timing of surgery for patients with gastric cancer (GC) who undergo neoadjuvant chemotherapy (neoCT) was mainly guided by serial radiologic imaging. However, an earlier assessment was indispensable to avoid delayed treatment for nonresponders and excessive toxicity for responders. Our previous study has identified circulating extracellular vesicles-derived lncRNA-GC1 as a biomarker for early detection and monitoring progression of GC. However, the potential role of neoCT remains poorly understood.
The potential impact of ChatGPT/GPT-4 on surgery: will it topple the profession of surgeons?
Authors: Kunming Cheng, Zaijie Sun, Yongbin He, Shuqin Gu, Haiyang Wu
Journal: International Journal of Surgery (2023)

aThe Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China. bDepartment of Orthopaedic Surgery, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China. cSchool of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing, China. dDuke Human Vaccine Institute, Duke University Medical Center, Durham, North Carolina, USA. eClinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China. fDuke Molecular Physiology Institute, Duke University School of Medicine, Durham, North Carolina, USA. Kunming Cheng, Zaijie Sun and Yongbin He. These authors have contributed equally to this work and share the first authorship. The data underlying this article will be shared by the corresponding author on reasonable request. Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article. *Corresponding author. Address: E-mail address: [email protected] (H. Wu). *Corresponding author. Address: E-mail address: [email protected] (S. Gu). Supplemental Digital Content is available for this article. Direct URL citations are provided in the HTML and PDF versions of this article on the journal's website, www.journal-surgery.net. Published online ■ ■ This is an open access article distributed under the Creative Commons Attribution-ShareAlike License 4.0, which allows others to remix, tweak, and build upon the work, even for commercial purposes, as long as the author is credited and the new creations are licensed under the identical terms. http://creativecommons.org/licenses/by-sa/4.0/
Impact of HER2 on prognosis and benefit from adjuvant chemotherapy in stage II/III gastric cancer patients: a multicenter observational study
Authors: Xianchun Gao, Lulu Zhao, Nannan Zhang, Weili Han, Kun Liu, Junya Yan, Ling Chen, Yan Pan, Renlong Li, Wenjiao Li, Haohao Zhang, Hongwei Li, Shibo Wang, Xiaoliang Gao, Penghui Niu, Wanqing Wang, Gang Ji, Qingchuan Zhao, Yuanyuan Lu, Zengshan Li, Lei Shang, Han Liang, Kaichun Wu, Jingyu Deng, Yingtai Chen, Yongzhan Nie
Journal: International Journal of Surgery (2023)

Background: Human epidermal growth factor receptor 2 (HER2) is a well-developed therapeutic target in breast and gastric cancer (GC). However, the impact of HER2 on survival and benefit from fluorouracil-based adjuvant chemotherapy remains unclear in patients with GC. Materials and Methods: This multicenter cohort study involved 5622 consecutive stage II/III GC patients. HER2 expression was assessed prospectively via immunohistochemistry (IHC). The staining intensity was graded on a scale of 0 to 3+. An IHC score of 2+or 3+was defined as high expression, and a score of 3+was defined as overexpression. Results: HER2 overexpression was independently associated with a lower 5-year overall survival (OS) in stage II [hazard ratio (HR), 2.10; 95% CI: 1.41–3.11], but not in stage III GC (HR, 1.00; 95% CI, 0.82–1.20). Further analysis revealed that stage II patients with high HER2 expression showed a poorer response to chemotherapy than stage II patients with low HER2 expression ( P interaction =0.024). The HRs for 5-year OS were 0.51 (95% CI, 0.38–0.70) for stage II patients with low HER2 expression, 0.58 (95% CI, 0.51–0.66) for stage III patients with low HER2 expression, 1.13 (95% CI, 0.61–2.09) for stage II patients with high HER2 expression, and 0.47 (95% CI, 0.36–0.61) for stage III patients with high HER2 expression. Conclusions: Fluorouracil-based adjuvant chemotherapy is insufficient for stage II GC patients with high HER2 expression, indicating that prospective trials are required to validate alternative HER2-targeted adjuvant therapies in the individuals above.
Minimally invasive nephrolithotomy versus retrograde intrarenal surgery in surgical management of Lower calyceal stones: a systematic review with meta-analysis
Authors: Ming Liu, Jun Hou, FeiHong Xu, HuiFang Du, JingXuan Liu, Ning Li
Journal: International Journal of Surgery (2023)

Objective: The efficacy and safety of minimally invasive nephrolithotomy (MPCNL) versus retrograde intrarenal surgery (RIRS) was assessed for lower calyceal (LC) stones. Methods: Our team conducted a systematic literature search up to December, 2022, using PUBMED, EMBASE and the Cochrane Library. The study was registered in PROSPERO, CRD 42021247197. Randomized controlled trials evaluating the efficacy and safety of MPCNL versus RIRS for LC stones were collected. Heterogeneity among the studies was assessed using the χ 2 test based on the Q and I 2 tests. Pooled effect sizes were calculated using a fixed model if I 2 is less than 50%; otherwise, a random-effects model was chosen. The primary outcomes were the 3-month stone-free rate (3SFR) and total complications, while the secondary outcomes were the operating time, hospital stay, haemoglobin reduction, bleeding, postoperative fever and complications with the Clavien–Dindo system. A subgroup analysis of 10–20 mm LC stones was also designed. Results: A total of 7 peer-reviewed trials comprising 711 patients were identified. No statistical differences were observed in the heterogeneity results of the 3SFR or total complications ( P &gt;0.1, I 2 &lt; 50%). Compared with RIRS, MPCNL had an unfavourable safety profile, resulting in total complications [odds ratio (OR): 1.87 (95% CI: 1.05, 3.33); P =0.03], haemoglobin reduction [OR: 0.81 (95% CI: 0.15, 1.47); P =0.02] and complications with Grade I [OR: 5.52 (95% CI: 1.34, 22.83); P =0.02] but an improved efficacy and 3SFR [OR: 2.43 (95% CI: 1.48, 3.97); P =0.0004]. As for the 10–20 mm LC stones, compared with RIRS, MPCNL also had an unfavourable safety profile, resulting in total complications [OR: 2.47 (95% CI: 1.20, 5.07); P =0.01], complications with Grade I [OR: 4.97 (95% CI: 0.99, 25.01); P =0.05] and an increased hospital stay [OR: 2.46 (95% CI: 2.26, 2.66); P =0.00001] but an improved efficacy and 3SFR {OR: 3.10 (95% CI: 1.61, 5.99); P =0.0008]. The efficacy effect of MPCNL and safety effect of RIRS were nearly equal for both stones sized less than 20 mm (number needed to treat = 17, number needed to harm = 20) and stones sized 10–20 mm (number needed to treat = 20, number needed to harm = 13). No statistical difference was found between the MPCNL and RIRS groups for the rest of outcomes. Conclusion: Both MPCNL and RIRS are safe and effective management methods. Moreover, compared with RIRS, MPCNL had an unfavourable safety profile but improved efficacy for LC stones of ≤20 mm or 10–20 mm, and the differences were statistically significant. The relative profit of efficacy of MPCNL was similar to the relative profit of safety of RIRS.
Artificial intelligence in surgical education and training: opportunities, challenges, and ethical considerations – correspondence
Authors: Prakasini Satapathy, Alaa H. Hermis, Sarvesh Rustagi, Keerti B. Pradhan, Bijaya K. Padhi, Ranjit Sah
Journal: International Journal of Surgery (2023)

Satapathy, Prakasini PhD; Hermis, Alaa Hamza MS; Rustagi, Sarvesh PhD; Pradhan, Keerti Bhusan PhD; Padhi, Bijaya K PhD; Sah, Ranjit MD Author Information
The role of laparoscopic adrenalectomy in the treatment of large pheochromocytomas (&gt;6 cm): a meta-analysis and systematic review
Authors: Lijian Gan, Lei Peng, Chunyang Meng, Lei Zheng, Zhiqiang Zeng, Si Ge, Zuoping Wang, Kangsen Li, Yunxiang Li
Journal: International Journal of Surgery (2023)

Background: The effectiveness and safety of laparoscopic adrenalectomy (LA) under different routes for the treatment of large pheochromocytomas (PCCs) is unknown. Materials and methods: This meta-analysis and systematic review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (Assessing the methodological quality of systematic reviews) Guidelines. Three databases were systematically searched, including Medline, PubMed, and Web of Science. The time frame of the search was set from the creation of the database to October 2022. Perioperative outcomes were divided into two groups according to tumor size: SMALL group (≤6 cm in diameter), LARGE group (&gt;6 cm in diameter). Results: Eight studies including 600 patients were included. In the LA group, complications was comparable in both groups (SMALL group and LARGE group), and the LARGE group had longer operative time [OT weighted mean difference (WMD)=32.55; 95% CI: 11.17, 53.92; P &lt;0.01], length of stay (LOS WMD=0.82; 95% CI: 0.19, 1.44; P &lt;0.05), more estimated blood loss (EBL WMD=85.26; 95% CI: 20.71, 149.82; P &lt;0.05), hypertension [odds ratio (OR)=3.99; 95% CI: 1.84, 8.65; P &lt;0.01], hypotension (OR=1.84; 95% CI: 1.11, 3.05; P &lt;0.05), and conversion (OR=5.60; 95% CI: 1.56, 20.13; P &lt;0.01). In the transabdominal LA group, OT, LOS, EBL, complications, hypertension, and hypotension were the same in both groups. In the retroperitoneal LA group, complications and hypotension were the same in both groups, while the LARGE group had longer OT (WMD=52.07; 95% CI: 26.95, 77.20; P &lt;0.01), LOS (WMD=0.51; 95% CI: 0.00, 1.01; P &lt;0.05), more EBL (WMD=92.99; 95% CI: 27.70, 158.28; P &lt;0.01) and higher rates of hypertension (OR=6.03; 95% CI: 1.95, 18.61; P &lt;0.01). Conclusions: LA remains a safe and effective approach for large PCC. Transabdominal LA is superior to retroperitoneal LA.
Surgical outcomes following breast reconstruction in patients with and without a history of chest radiotherapy for Hodgkin lymphoma: a multicentre, matched cohort study
Authors: J. Xavier Harmeling, Leonie A.E. Woerdeman, Ezgi Ozdemir, Michael Schaapveld, Hester S.A. Oldenburg, Cécile P.M. Janus, Nicola S. Russell, Linetta B. Koppert, Inge M. Krul, Flora E. van Leeuwen, Marc A.M. Mureau
Journal: International Journal of Surgery (2023)

Background: Breast cancer is the most common treatment-related second malignancy among women with previous chest radiotherapy for Hodgkin lymphoma (HL). Little is known about the effects of this kind of radiotherapy on the outcomes of postmastectomy breast reconstruction (BR). This study compared adverse outcomes of BR after HL-related chest radiotherapy to matched controls. Methods: The authors conducted a retrospective, matched cohort study in two expert cancer centres in the Netherlands. BRs after therapeutic or prophylactic mastectomy in HL survivors who received chest radiotherapy were matched with BRs in nonirradiated patients without HL on age at mastectomy date, date of BR, and type of BR. The primary outcome was complication-related BR failure or conversion and secondary outcomes were complication-related re-operation, capsular contracture, major donor-site complications, and complication-related ICU admission. The authors analyzed all outcomes univariably using Fisher’s exact tests and the authors assessed reconstruction failure, complication-related re-operation, and capsular contracture with multivariable Cox regression analysis adjusting for confounding and data clustering. Results: Seventy BRs in 41 patients who received chest radiotherapy for HL were matched to 121 BRs in 110 nonirradiated patients. Reconstruction failure did not differ between HL survivors (12.9%) and controls (12.4%). The comparison groups showed no differences in number of reoperations, major donor-site complications, or capsular contractures. BR in HL survivors more often let to ICU admission due to complications compared with controls ( P =0.048). Conclusions: We observed no increased risk of adverse outcomes following BR after previous chest radiotherapy for HL. This is important information for counselling these patients and may improve shared decision-making.
Macrophage morphology and distribution are strong predictors of prognosis in resected colorectal liver metastases: results from an external retrospective observational study
Authors: Guido Costa, Carlo Sposito, Cristiana Soldani, Michela A. Polidoro, Barbara Franceschini, Federica Marchesi, Faizan D. Nasir, Matteo Virdis, Andrea Vingiani, Ana Leo, Luca Di Tommaso, Soumya Kotha, Alberto Mantovani, Vincenzo Mazzaferro, Matteo Donadon, Guido Torzilli
Journal: International Journal of Surgery (2023)

Tumor-associated macrophages (TAMs) are key components of a tumoral microenvironment and have been shown to impact prognosis in different cancers. Previously reported data showed that TAM morphology correlates with prognosis in colorectal liver metastases (CLMs) after hepatectomy, with smaller TAMs (S-TAMs) conferring a more favorable prognosis than larger ones (L-TAMs). This study aims to externally validate this finding.The external cohort consisted of 84 formalin-fixed and paraffin-embedded surgical samples of CLMs and peritumoral tissue. Two-micrometer-section slides were obtained; the area and perimeter of 21 macrophages in each slide were recorded. The endpoints were TAMs morphometrics and their prognostic significance in relation to disease-free survival (DFS).The average macrophage perimeter was 71.5±14.1 μm whilst the average area was 217.7±67.8 μm 2 . At univariate analysis, the TAM area demonstrated a statistically significant association with DFS ( P =0.0006). Optimal area cutoff value was obtained, showing a sensitivity and specificity of 92 and 56%, respectively. S-TAMs and L-TAMs were associated with 3-year DFS rates of 60 and 8.5%, respectively ( P <0.001). Multivariate analysis confirmed the predictive role of TAM area for DFS [hazard ratio (HR)=5.03; 95% CI=1.70-14.94; P =0.003]. Moreover, in a subset of patients ( n =12) characterized by unfavorable ( n =6, recurrence within 3 months) or favorable ( n =6, no recurrence after 48 months) prognosis, TAMs showed a different distribution: L-TAMs were more abundant and closer to the tumor invasive margin in patients that encountered early recurrence and tended to cluster in foci significantly larger ( P =0.02).This external validation confirms that morphometric characterization of TAMs can serve as a simple readout of their diversity and allows to reliably stratify patient outcomes and predict disease recurrence after hepatectomy for CLMs.
Effectiveness of pandemic and seasonal influenza vaccine in preventing pandemic influenza A(H1N1)2009 infection in England and Scotland 2009-2010
Authors: P Hardelid, D M Fleming, J McMenamin, N Andrews, C Robertson, P Sebastianpillai, J Ellis, W Carman, T Wreghitt, J  M Watson, R  G Pebody
Journal: Eurosurveillance (2011)

Following the global spread of pandemic influenza A(H1N1)2009, several pandemic vaccines have been rapidly developed. The United Kingdom and many other countries in the northern hemisphere implemented seasonal and pandemic influenza vaccine programmes in October 2009. We present the results of a case–control study to estimate effectiveness of such vaccines in preventing confirmed pandemic influenza infection. Some 5,982 individuals with influenza-like illness seen in general practices between November 2009 and January 2010 were enrolled. Those testing positive on PCR for pandemic influenza were assigned as cases and those testing negative as controls. Vaccine effectiveness was estimated as the relative reduction in odds of confirmed infection between vaccinated and unvaccinated individuals. Fourteen or more days after immunisation with the pandemic vaccine, adjusted vaccine effectiveness (VE) was 72% (95% confidence interval (CI): 21% to 90%). If protection was assumed to start after seven or more days, the adjusted VE was 71% (95% CI: 37% to 87%). Pandemic influenza vaccine was highly effective in preventing confirmed infection with pandemic influenza A(H1N1)2009 from one week after vaccination. No evidence of effectiveness against pandemic influenza A(H1N1)2009 was found for the 2009/10 trivalent seasonal influenza vaccine (adjusted VE of -30% (95% CI: -89% to 11%)).
HSF1 promotes CD69<sup>+</sup> Treg differentiation to inhibit colitis progression
Authors: Lei Yu, Bingluo Zhou, Yiran Zhu, Ling Li, Yiming Zhong, Liyuan Zhu, Hanying Wang, Hui Chen, Jinye Xu, Tianxin Guo, Lifeng Feng, Xian Wang, Zhijian Cai, Jianli Wang, Hongchuan Jin
Journal: Theranostics (2023)

Regulatory T cells (Tregs) are critical for generating and maintaining peripheral tolerance.Treg-based immunotherapy is valuable for the clinical management of diseases resulting from dysregulation of immune tolerance.However, the lack of potency is a potential limitation of Treg therapy.In addition, CD69 positive-Treg (CD69 + Treg) represent a newly identified subset of Tregs with potent immune suppressive capability.Methods: Foxp3 YFP-Cre CD69 fl/fl and CD4 Cre CD69 fl/fl mice were generated to determine the relevance of CD69 to Treg.Chromatin Immunoprecipitation Assay (ChIP) and luciferase Assay were performed to detect the regulation of CD69 transcription by heat shock transcription factor 1(HSF1).Gene expression was measured by western blotting and qRT-PCR.The differentiation of naive T cells to CD69 + Foxp3 + iTregs was determined by flow cytometry.The immunosuppressive ability of Tregs was analyzed by ELISA and flow cytometry.Colon inflammation in mice was reflected by changes in body weight and colon length, the disease activity index (DAI), and H&E staining of colon tissues.Results: Induced Tregs (iTregs) from CD4 Cre CD69 fl/fl mice failed to alleviate colitis.The transcription factor HSF1 interacted with the promoter of the CD69 gene to prompt its transcription during Treg differentiation.Genetic and chemical inhibition of HSF1 impaired CD69 + Treg differentiation and promoted the pathogenesis of colitis in mice.In contrast, HSF1 protein stabilized by inhibiting its proteasomal degradation promoted CD69 + Treg differentiation and alleviated colitis in mice.Moreover, adoptive transfer of iTregs with HSF1 stabilization by proteasome inhibitor (PSI) dramatically prevented the development of colitis in mice and was accompanied by decreased production of pro-inflammatory cytokines and reduced accumulation of pro-inflammatory lymphocytes in colitis tissue, whereas Tregs induced in the absence of PSI were less stable and ineffective in suppressing colitis.Conclusions: HSF1 promotes CD69 + Tregs differentiation by activating the CD69 transcription, which is critical for the immunosuppressive function of Tregs.Stabilization of HSF1 by PSIs results in the efficient generation of Tregs with high potency to treat colitis and probably other autoimmune diseases involving Tregs deficiency.
Diagnosis and biomarkers for ocular tuberculosis: From the present into the future
Authors: Zhang Ludi, Ashita Ashish Sule, Ramar Perumal Samy, Ikhwanuliman Putera, Benjamin Schrijver, Paul Edward Hutchinson, Jayantha Gunaratne, Indu Verma, Amit Singhal, Rina La Distia Nora, P. Martin van Hagen, Willem A Dik, Vishali Gupta, Rupesh Agrawal
Journal: Theranostics (2023)

Tuberculosis is an airborne disease caused by Mycobacterium tuberculosis (Mtb) and can manifest both pulmonary and extrapulmonary disease, including ocular tuberculosis (OTB).Accurate diagnosis and swift optimal treatment initiation for OTB is faced by many challenges combined with the lack of standardized treatment regimens this results in uncertain OTB outcomes.The purpose of this study is to summarize existing diagnostic approaches and recently discovered biomarkers that may contribute to establishing OTB diagnosis, choice of anti-tubercular therapy (ATT) regimen, and treatment monitoring.The keywords ocular tuberculosis, tuberculosis, Mycobacterium, biomarkers, molecular diagnosis, multi-omics, proteomics, genomics, transcriptomics, metabolomics, T-lymphocytes profiling were searched on PubMed and MEDLINE databases.Articles and books published with at least one of the keywords were included and screened for relevance.There was no time limit for study inclusion.More emphasis was placed on recent publications that contributed new information about the pathogenesis, diagnosis, or treatment of OTB.We excluded abstracts and articles that were not written in the English language.References cited within the identified articles were used to further supplement the search.We found 10 studies evaluating the sensitivity and specificity of interferon-gamma release assay (IGRA), and 6 studies evaluating that of tuberculin skin test (TST) in OTB patients.IGRA (Sp = 71-100%, Se = 36-100%) achieves overall better sensitivity and specificity than TST (Sp = 51.1-85.7%;Se = 70.9-98.5%).For nuclear acid amplification tests (NAAT), we found 7 studies on uniplex polymerase chain reaction (PCR) with different Mtb targets, 7 studies on DNA-based multiplex PCR, 1 study on mRNA-based multiplex PCR, 4 studies on loop-mediated isothermal amplification (LAMP) assay with different Mtb targets, 3 studies on GeneXpert assay, 1 study on GeneXpert Ultra assay and 1 study for MTBDRplus assay for OTB.Specificity is overall improved but sensitivity is highly variable for NAATs (excluding Ivyspring International